盐酸度洛西汀对带状疱疹后神经痛患者疼痛程度及睡眠质量的影响

目的探究盐酸度洛西汀对带状疱疹后神经痛患者疼痛程度及睡眠质量的影响。方法选取2017年5月～2019年1月我院接收的带状疱疹后神经痛患者86例,以随机数表法分为对照组和观察者各43例。对照组采用神经阻滞镇痛液治疗;观察组在对照组治疗基础上加用盐酸度洛西汀治疗。对比两组患者的疼痛程度和睡眠质量。结果治疗后不同时点,观察组视觉模拟评分法(VAS)、匹兹堡睡眠质量指数(PSQI)评分均低于对照组,差异具有统计学意义(P<0.05)。结论盐酸度洛西汀能够增强神经阻滞药物治疗带状疱疹后神经痛的效果,降低患者疼痛程度,改善患者睡眠质量,效果明显,值得推广。     

神经阻滞联合普瑞巴林治疗带状疱疹后神经痛的研究

目的比较单纯口服普瑞巴林和联合神经阻滞两种方法治疗带状疱疹后神经痛(PHN)的效果。方法 60例病程超过6个月的PHN患者分成两组,每组各30例。A组口服普瑞巴林;B组在口服药物的基础上行神经阻滞(三叉神经、肋间神经、椎旁阻滞或腰丛阻滞)。比较两组患者治疗前、治疗后3 d、1周、2周、3周、4周、5周、6周、7周、8周疼痛视觉模拟评分(VAS)和睡眠评分(采用汉密尔顿抑郁量表的第4、5、6项)。比较两组患者疼痛缓解>50%和>30%的人数,以及副作用的发生率。结果两组患者治疗后1~8周VAS和睡眠评分均低于治疗前(P<0.05),B组患者在治疗后3 d VAS及睡眠评分明显低于A组(P<0.01);B组患者疼痛缓解>50%的人数和疼痛缓解>30%的人数高于A组(P<0.05)。两组患者副作用无显著性差异。结论神经阻滞联合口服普瑞巴林治疗带状疱疹后神经痛起效快、止痛作用强,无严重副作用发生。     

抗病毒联合皮下及肋间神经阻滞治疗带状疱疹痛

目的：观察抗病毒治疗联合镇痛药物治疗带状疱疹痛的临床效果.方法：60例胸部带状疱疹神经痛患者随机分为三组,A组：皮内注射消炎镇痛药＋抗病毒治疗;B组：肋间神经阻滞＋抗病毒治疗;C组：单纯抗病毒治疗.以视觉模拟评分（VAS）和睡眠质量评分（QS）评定治疗效果.结果：治疗后从即刻开始至观察期（30d）结束,A、B组VAS评分较治疗前显著降低（P＜0.01）,睡眠状况也明显改善（P＜0.01）;而C组患者仅在第14天开始疼痛有所减轻,睡眠状况好转.结论：采用皮内注射或肋间神经阻滞行镇痛治疗、联合抗病毒药物治疗对带状疱疹患者的疼痛缓解和睡眠质量改善有很好的疗效.     

带状疱疹的早期综合治疗

目的:通过对带状疱疹的早期诊断及早期综合治疗,观察其对急性期疼痛缓解及后遗痛预防的疗效.方法:36例带状疱疹急性期病例随机分成治疗组及对照组,治疗组采用抗病毒药物、曲马多、加巴喷丁、局部神经阻滞及超激光照射治疗.对照组采用抗病毒药物、布洛芬缓释胶囊、局部神经阻滞及超激光照射治疗.采用VAS评分及睡眠影响指数(SIS)对疼痛程度及患者生活质量进行评价.结果:治疗前,治疗组VAS及SIS平均为6.81±1.76及6.62±1.86,对照组VAS及SIS平均为6.57±1.45及6.43±1.75;治疗五周后,治疗组VAS及SIS平均为1.38±1.47及1.02±1.71,对照组VAS及SIS平均为2.27±0.92及2.00±0.65.治疗组后遗痛的发生率为4.8%,对照组为13.3%.结论:带状疱疹的早期诊断及综合治疗不仅可以减轻急性症状,还可减少带状疱疹后神经痛(PHN)的发生率.     

选择性神经根阻滞联合皮内臭氧注射治疗疱疹后神经痛的近期临床观察

目的:观察选择性神经根阻滞联合局部皮内臭氧注射治疗带状疱疹后遗神经痛的疗效.方法:60名带状疱疹后遗神经痛患者,随机分成四组,A组(n=15):单纯药物治疗;B组(n=15):药物联合选择性神经根阻滞治疗;C组(n=15):药物联合局部皮内臭氧注射治疗;D组(n=15):同时给予药物治疗、选择性神经根阻滞及局部皮内臭氧注射治疗.观察治疗前以及治疗后不同时期疼痛程度变化,以视觉模拟评分(VAS)评定治疗效果.结果:治疗后,B,C,D组VAS评分均低于A组(P<0.05),且D组VAS评分明显低于B,C组(P<0.05).结论:采用选择性神经根阻滞联合局部皮内臭氧注射,辅以常规药物,能够迅速缓解疼痛,是治疗带状疱疹后遗神经痛的有效方法.     

神经阻滞联合抗病毒药物治疗早期带状疱疹神经痛

[目的]观察神经阻滞联合抗病毒药物治疗早期带状疱疹神经痛的疗效.[方法]选择急性带状疱疹神经痛发病1～2周的患者64例,随机分成抗病毒药物治疗组(A组)和神经阻滞联合抗病毒药物组(B组),每组32例.分别在治疗前和治疗后进行视觉模拟评分(VAS),1周评估一次,随诊12周,了解患者睡眠、疼痛情况及带状疱疹后遗神经痛(P...     

神经阻滞及局部浸润联合药物治疗带状疱疹后神经痛的疗效观察

目的观察神经阻滞及皮损区局部浸润联合药物治疗带状疱疹后神经痛的疗效。方法选择急性带状疱疹愈合后,疼痛时间持续超过3个月的患者57例,皮损部位分别在头面部、胸背部、上下肢及骶部。采用神经阻滞、皮损区局部浸润联合药物治疗,以视觉模拟评分(VAS)和睡眠质量评分(QS)综合评定治疗效果。结果治疗后第1～4周VAS评分及QS评分较治疗前显著降低(P<0.01)。显效率87.7%,总有效率100%。结论以神经阻滞和皮损区局部浸润联合药物治疗带状疱疹后神经痛,能迅速缓解疼痛,改善睡眠质量且副作用少,是目前较为理想的方法 。     

B超引导下胸椎旁神经阻滞治疗急性带状疱疹肋间神经痛的研究

目的:探讨B超引导下胸椎旁神经阻滞在治疗急性带状疱疹肋间神经痛中的临床疗效。方法:80例胸背部急性带状疱疹伴肋间神经痛患者随机分为两组,每组各40例。A组(对照组)予常规抗病毒及按需口服镇痛药物治疗,B组(试验组)同时接受在B超引导下选择性胸椎旁神经阻滞治疗。观察治疗后7、14及30天两组患者疼痛视觉模拟评分(VAS)、辅助镇痛药用量、不良反应及后遗神经痛(PHN)发生率。结果:治疗后各观察时间点两组VAS评分均较治疗前降低(P0.009),组间比较差异显著,B组明显低于A组(P0.05)。辅助镇痛药物用量、PHN发生率B组亦显著低于A组(P0.05)。两组均无明显不良反应发生。结论:B超引导下胸椎旁神经阻滞联合抗毒治疗急性带状疱疹肋间神经痛安全有效,明显优于单纯药物治疗,并可减少后遗神经痛的发生率,值得临床推广应用。     

普瑞巴林联合神经阻滞在老年人头面颈部带状疱疹后神经痛中的应用

目的观察不同剂量普瑞巴林联合神经阻滞治疗老年人头面部带状疱疹后神经痛的有效性和安全性。方法头面部带状疱疹后神经痛老年患者54例,随机分为低剂量组和高剂量组。高剂量组采用三叉神经分支阻滞和皮损区皮内注射治疗每星期一次,治疗1个月,并从治疗开始时口服普瑞巴林300 mg/d,bid直至第10周,低剂量组采用相同的神经阻滞疗法并从治疗开始时口服普瑞巴林150 mg/d,bid直至第10周。用视觉模拟评分(visual analoguescale,VAS)和睡眠质量评分(quality of sleep,QS)评价治疗效果,并观察治疗后的不良反应。结果与治疗前比较,两组治疗后第1～10w,VAS和QS评分均显著下降(P<0.05);与低剂量组相比,高剂量组治疗后第5w和第4w开始VAS评分和QS评分分别降低,且差异有统计学意义(P<0.05);两组患者治疗后10周,不良反应无明显差别。结论普瑞巴林300 mg/d联合神经阻滞可迅速缓解老年头面部带状疱疹后神经痛,改善睡眠质量,且无明显不良反应,值得临床推广。     

椎旁阻滞联合牛痘疫苗接种家兔炎症皮肤提取物治疗带状疱疹神经痛的疗效观察

目的:观察单纯药物治疗及联合椎旁神经阻滞治疗胸腰背部带状疱疹神经痛的疗效。方法:选择2009年3月至2010年5月我院门诊及住院的60例经确诊患带状疱疹皮损已痊愈而后持续、剧烈、顽固性疼痛、痛觉过敏、麻木、感觉异常且自然病程1~22月,病变累及范围限于T1~L5节段神经支配区的患者,将其随机分为椎旁阻滞与牛痘疫苗接种家兔炎症皮肤提取物(神经妥乐平,NTP)联合用药组(阻滞组)及单纯NTP组(单药组),每组30例。分别给予静脉NTP制剂7.2 NU,每日静滴,连续应用15天。阻滞组在此基础上据疱疹累及的脊神经节段分别给予腰椎旁、胸椎旁神经阻滞治疗,观察患者阻滞及用药后1 d、7 d、15 d、30 d麻木、痛觉过敏、睡眠障碍的改善情况。结果:阻滞组镇痛有效率90.0%,与单药组镇痛有效率63.3%比较差异显著(P<0.01),治疗后1、7、15、30天VAS评分,QS评分较治疗前均有改善(P<0.05),睡眠障碍明显改善(P<0.05)。两组间比较,VAS评分、QS评分、痛觉过敏等症状,阻滞组显著降低(P<0.05)。结论:椎旁神经阻滞联合牛痘疫苗接种家兔炎症皮肤提取物治疗带状疱疹神经痛疗效明显优于单纯神经修复药组,且效果持续,副作用小。     

Supraorbital neuralgia. On the clinical manifestations and a possible therapeutic approach

The clinical manifestations of supraorbital neuralgia are apparently only incompletely known. The lack of awareness of this head pain may possibly be due to its rarity and problems with making the diagnosis. In the present work, the long-term result of minor, decompressive surgery of the supraorbital nerve in five patients is reported. The immediate improvement was good and, after a mean observation time of more than 6 years, an improvement of 50% to 100% was observed (mean, circa 85%). In the two patients with the longest postoperative observation time, approximately 8 years, pain has not recurred.
The pain was severe, leading to suicidal thoughts in several patients. The long-term course was intermittent or continuous. The pain was generally unilateral, but was bilateral in one patient. Generally, there was lack of, or only minor benefit from drug treatment, including carbamazepine and indomethacin. There was clearly tenderness over the supraorbital nerve, especially at its outlet, and in some subjects occasionally, a slight local loss of sensation. Definite trigger zones were not present. Supraorbital nerve blockade generally provided instant and considerable pain relief. The persistence of protracted unilateral forehead/ocular pain, tenderness over the nerve, and repeated blockade effect strongly suggests the diagnosis.     

微血管减压术治疗三叉神经痛及舌咽神经痛1150例报告

目的:探讨用微血管减压术治疗三叉神经痛、舌咽神经痛等神经血管压迫综合症治疗方法的改进措施和提高治疗效果的临床经验。方法:系统回顾1984年6月至1999年12月我们采用微血管减压术治疗神经血管压迫综合症病例1150例,其中三叉神经痛1120例,舌咽神经痛30例。结果:有效1112例,有效率为96.7％,本组无死亡。并发症发生率由5年前5.6％下降到近5年的1.6％。结论:提高微血管减压术的治愈率和减少并发症,有多方面因素值得考虑。     

A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛的临床疗效

目的：观察A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛的临床效果。方法：选取33例三叉神经痛或带状疱疹后神经痛患者，进行疼痛区域A型肉毒毒素皮下或皮内注射治疗，评估患者治疗时、治疗2周后、治疗3个月后疼痛情况（NRS）、睡眠状况及生活质量（QOL），判断治疗效果，观察药物不良反应。结果：患者使用A型肉毒毒素治疗2周后、3个月后疼痛评分、睡眠评分显著低于治疗时（P<0.05），生活质量显著高于治疗时（P<0.05），治疗效果好，不良反应少。结论：A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛效果显著，可成为神经病理性疼痛治疗的一种新途径。     

Glossopharyngeal neuralgia referred from a pontine lesion

Paroxysmal pain in the form of glossopharyngeal neuralgia is less frequent and less well understood than that of trigeminal neuralgia. Diagnostic confusion can arise especially when both conditions occur in the one patient. We report a patient with a 20-year history of left-sided glossopharyngeal neuralgia with trigger zones in both the trigeminal and glossopharyngeal dermatomal distributions. Magnetic resonance imaging revealed a single T2-weighted hyperintense signal in the left pons with no other abnormality. It is postulated that ephaptic transmission between central pain fibers and the trigeminal or glossopharyngeal fibers, which both enter the spinal trigeminal tract, resulted, respectively, in conventional and "referred" glossopharyngeal neuralgia.     

Paroxysmal head pain with backward radiation: will epicrania fugax go in the opposite direction?

Epicrania fugax (EF) has been recently described as a paroxysmal head pain starting in a focal cranial area of the posterior scalp and rapidly spreading forward to the ipsilateral eye or nose along a linear or zigzag trajectory. Here we report two patients presenting with the same clinical features, except for the starting site and the direction of the pain. Unilateral pain paroxysms occurred on either side of the head, with a quick backward radiation along a linear trajectory. The pain always stemmed from a particular point located at the fronto-parietal region, and reached the parieto-occipital region in several seconds. The symptoms did not fit any of the acknowledged headaches and neuralgias, and might correspond to a reverse variant of EF.     

Urgent care peripheral nerve blocks for refractory trigeminal neuralgia

Objective

After medication failure, patients with refractory trigeminal neuralgia (TGN) often present urgently and seek more potent or invasive therapies such as opioids or surgical options. Peripheral nerve blocks, safe and simple, may offer extended pain relief prior to opioid use or more invasive ganglion level procedures.

Ultrasound‐Guided Peristyloid Steroid Injection for Eagle Syndrome

The styloid process arising from the temporal bone is normally about 2.5 cm in length. For various reasons, including trauma and inflammation, it may become elongated. This elongated styloid process, when symptomatic with clinical signs and symptoms suggestive of local compression or neuropathic pain, is termed Eagle syndrome. Glossopharyngeal neuralgia is characterized by intermittent shooting sharp pain in the jaw, throat, tongue, and ear. Conservative management includes anticonvulsants, tricyclic antidepressants, and anti‐inflammatory agents. Interventional and surgical options are pursued when these fail. Fluoroscopy is usually used to position the needle adjacent to the styloid process for injecting steroid and or local anesthetic. We describe a case of a 41‐year‐old woman with Eagle syndrome who failed conservative management and subsequently underwent an ultrasound‐guided peristyloid steroid injection with short‐duration pain relief.